Spine
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Randomized Controlled Trial Clinical Trial
Cost effectiveness of periradicular infiltration for sciatica: subgroup analysis of a randomized controlled trial.
A subgroup analysis of a prospective, randomized controlled trial was performed. ⋯ In addition to short-term effectiveness for contained herniations and lesions at L3-L4-L5, steroid treatment also prevented surgery for contained herniations. However, steroid was countereffective for extrusions. The results of the subgroup analyses call for a verification study.
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Patients with low back pain, sciatica, and neurogenic claudication were observed during computed tomographic myelography or magnetic resonance imaging in psoas-relaxed position and axially compressed supine position of the lumbar spine. ⋯ According to the study results, axially loaded imaging adds frequent additional valuable information, as compared with conventional imaging methods, especially in patients with neurogenic claudication, but also in patients with sciatica if defined inclusion criteria are used.
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A case report of a multidisciplinary approach to a second reconstructive back surgery in a patient with von Willebrand's disease, flatback syndrome, and a history of heavy surgical bleeding is presented. ⋯ Using a careful multidisciplinary approach, excellent hemostasis can be achieved with minimal exposure to untreated allogeneic blood products during aggressive spinal surgery in a patient with a clinically significant congenital coagulopathy.
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The clinical data, magnetic resonance imaging, intraoperative findings, and functional outcome were reviewed for three patients under anticoagulant therapy who experienced acute nontraumatic spinal subdural hematoma. ⋯ Spinal subdural hematoma must be considered in patients under anticoagulant therapy with spontaneous signs of acute spinal cord or cauda equina compression. Magnetic resonance imaging with sagittal T1- and T2-weighted images were adequate and reliable for diagnosis of spinal subdural hematoma. On the basis of previous studies and the authors' intraoperative findings, spinal subdural hematomas could be viewed as spinal dural border hematomas. The level of preoperative neurologic deficit seemed to be critical for recovery despite prompt surgical evacuation.
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A case series of seven children who had a thoracolumbar gibbus related to mucopolysaccharidosis treated with anterior instrumentation were reported retrospectively. ⋯ Anterior instrumented correction and fusion of the spine is effective in treating thoracolumbar kyphosis associated with mucopolysaccharidosis.